Many Women Don't Get Breast Reconstruction After Mastectomy

Older Women, Those on Medicare Less Likely to Have Reconstruction Immediately

By Charlene Laino
WebMD Health News

Reviewed by Laura J. Martin, MD

Dec. 8, 2011 (San Antonio) -- Despite the psychological and cosmetic benefits, fewer than 1 in 4 women with insurance have breast reconstruction immediately after having a mastectomy to treat their breast cancer.

Women who are on Medicare or Medicaid, who are older, who are black, and who are treated at rural or non-teaching hospitals are even less likely to have immediate reconstructive surgery. Research has shown that breast reconstruction improves patients' psychological and sexual well-being.

The vast majority women would rather have reconstruction at the time of mastectomy so they don't have to undergo a second surgery later, says Dawn Hershman, MD, who headed up the study. She is an assistant professor of medicine and epidemiology at Columbia University Medical Center in New York City.

"For all those reasons, we were surprised to see that although the use of immediate reconstruction has increased over the past decade, the rates still remain so low," she tells WebMD. The study involved more than 100,000 insured women with breast cancer who underwent mastectomy between 2000 and 2010.

Private Insurers Cover More

The research was presented at the 2011 San Antonio Breast Cancer Symposium. Among the findings:

  • Overall, 42% of women younger than 50 and 17% of women 50 and older underwent immediate reconstruction over the 10 year period.
  • The percentage of women opting for immediate reconstruction increased steadily from 15% in 2000 to 33% in 2010.The largest increase came from women under 50 (from 29% to 60%) and women with private insurance (from 25% to 55%).
  • Women with very early breast cancer known as ductal carcinoma in situ, or DCIS, were more likely to undergo immediate reconstruction than those with cancers that had invaded the breast.

Women with private insurance are more likely to have a greater portion of the cost covered, says Patricia Ganz, MD, director of prevention and control research at UCLA Jonsson Comprehensive Cancer Center.

While the price tag of mastectomy remained stable over the decade, the cost of immediate reconstruction tripled, Hershman says. The hospital stay -- for mastectomy plus the plastic surgery -- runs about $15,000 if a woman opts for implants and $17,000 if breasts are rebuilt using tissue from her body, she says.

"Not everyone wants or should have [reconstructive surgery]. But there should be universal access regardless of type of insurance," Hershman says.

These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

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SOURCES: San Antonio Breast Cancer Symposium, San Antonio, Dec. 6-10, 2011.Dawn Hershman, MD, assistant professor, medicine and epidemiology, Columbia University Medical Center, New York City.Patricia Ganz, MD, director of prevention and control research, UCLA Jonsson Comprehensive Cancer Center.

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